What are the responsibilities and job description for the Claims Quality Auditor position at University of California - Los Angeles Health?
Take on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health.
The Claims Quality Auditor will be responsible for the daily audit of all examiners assigned to the auditor. You will review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures. You will:
- Research over and under-payment inquiries/appeals
- Compile and maintain statistical data consistent
- Maintain departmental production and quality standards
We're seeking a self-motivated, detail-oriented, deadline-driven individual with:
- High school diploma, GED or equivalent
- Minimum five years of medical claims payment experience in an HMO environment
- Experience with CPT-4, ICD-9CM, RBRVS, ASA, and HCPCS
- Understanding of Medicare Guidelines and COB
- Knowledge of medical terminology
- Experience in benefit determination and claims adjudication
- Ability to accurately key 6,000-8,000 keystrokes or type 40-50 WPM
- Understanding of professional and facility reimbursement methodologies
- Strong organizational skills
- Computer proficiency with Microsoft Office
- Knowledge of claims adjudication systems
- Flexibility and adaptability
UCLA Health is a world-renowned health system with four award-winning hospitals and more than 250 community clinics throughout Southern California. We are also home to the David Geffen School of Medicine, a highly respected leader in the development of breakthrough medical research and outstanding clinical professionals. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.
University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. For the complete University of California nondiscrimination and affirmative action policy, see: UC Nondiscrimination & Affirmative Action Policy.
Salary : $24 - $48